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Edit 01238
Service License not on NYS License File
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N291
HIPAA Healthcare Claim Status Code: 143
Entity Identifier Code: SJ
Potential Causes:
The Servicing Provider ID License Number is not on file. If an MMIS Provider ID Number was entered as the Service Provider, then this edit means that the qualifier entered was a 0B and it should be a 1D. If the Service Provider information contained a license type code, then an MMIS Provider ID should not be sent.
Solution:
Please check your information in the following loop and segments and re-submit.
| 837 Institutional |
Loop 2310A, REF (Attending Physician Secondary Identification)
REF01 = 1D or 0B (Reference Identification Qualifier)
REF02 = Provider ID or License Number (Reference Identification) |
| 837 Professional |
Loop 2310B, REF (Rendering Provider Secondary Identification)
REF01 = 1D or 0B (Reference Identification Qualifier)
REF02 = Provider ID or License Number (Reference Identification)
Or
Loop 2420A, REF (Rendering Provider Secondary Identification)
REF01 = 1D or 0B (Reference Identification Qualifier)
REF02 = Provider ID or License Number (Reference Identification)
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| 837 Dental |
Loop 2310B, REF (Rendering Provider Secondary Identification)
REF01 = 1D or 0B (Reference Identification Qualifier)
REF02 = Provider ID or License Number (Reference Identification)
Or
Loop 2420A, REF (Rendering Provider Secondary Identification)
REF01 = 1D or 0B (Reference Identification Qualifier)
REF02 = Provider ID or License Number (Reference Identification)
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